대장암에 의한 장 폐쇄 환자에서 자가팽창형 금속제 스텐트 삽입술의 효과에 대한 다기관 연구 - 응급수술군과의 비교를 통한 임상 효과 및 의료 경제학적 분석을 중심으로 -

Abstract

BACKGROUND/AIMS: The aim of this study was to evaluate the clinical and cost effectiveness of the use of stent insertion for malignant colorectal obstruction as compared with performing emergency surgery. METHODS: We retrospectively reviewed the medical records of 201 patients. Malignant colorectal obstructions caused by a resectable tumor were treated with preoperative stenting followed by surgery (group A, n=55) or emergency surgery (group B, n=59). Malignant obstructions caused by an unresectable cancer were treated with palliative stenting (group C, n=58) or palliative emergency surgery (group D, n=29). RESULTS: The one-staged radical resection rate was significantly higher in group A patients than in group B patients (87.3% vs. 52.5%, p<0.05). Post-operative complications were more frequent in group A patients than in group B patients (9.1% vs. 32.2%, p<0.05). The admission period was significantly shorter for group A patients than for group B patients (25.0 days vs. 33.7 days, p<0.05). The medical cost was not different for group A and group B patients. Life-long stoma formation was necessary for 15.5% of group C patients and 69% of group D patients, respectively. The admission period was significantly shorter for group C patients than group D patients (10.5 days vs. 22.7 days, p<0.05). The medical cost was not different for group C and D patients. CONCLUSIONS: Stent insertion was an effective treatment modality for malignant colorectal obstruction.